Public Policy is social agreement written down as a universal guide for social action. We at The Policy ThinkShop share information so others can think and act in the best possible understanding of "The Public Interest."

Perhaps one of the most terrible things about life is that it ends. At the same time, the fragility of life is perhaps what also makes it beautiful and precious for many of us. And so, it is perhaps most painful when we have to see others die than it is to finally succumb ourselves. In the behavioral health profession this process of experiencing the death of others is referred to at grief and loss… Most of us do not handle it very well. Both the lead up to it, the moment when it happens and then our often long process of trying to understand and deal with it.

The Policy ThinkShop recommends the following Harvard medical resource to help you broaden your perspective on death and dying–the inevitable crisis we often face more than once in our lives.

“Compassionate advice for dealing with the loss of a loved one. The loss of a loved one can be a profoundly painful experience. The grief that follows may permeate everything, making it hard to eat, sleep, or muster much interest in the life going on around you.

This emotional maelstrom can affect behavior and judgment. It’s common, for example, to feel agitated or exhausted, to sob unexpectedly, or to withdraw from the world. Some people find themselves struggling with feelings of sorrow, numbness, anger, guilt, despair, irritability, relief, or anxiety.

While no words can erase grief, Coping with Grief and Loss can help you navigate this turbulent time.

In its pages, you’ll find advice on comforting yourself, commemorating your loved one, and understanding the difference between grief and depression. You’ll also find special sections on coping with the loss of a child, parent, or spouse.

Coping with Grief and Loss also includes information on navigating life when a loved one is terminally ill, on end-of-life planning, and on ways to talk about death.

Loss affects people in different ways. There is no “right” way to grieve, and no timetable or schedule for grieving. This Special Health Report aims to help you cope with the loss of a loved one at your own pace and in your own way. It offers numerous physical, emotional, and social strategies that help healing take place.”

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The Policy ThinkShop team wishes you and all of our visitors this year a happy holiday season and a prosperous new year!

Here are some fun facts about our health that will get us thinking about a healthier future and a happy 2014 from the Gallup organization:

Highlights from the health and well-being findings Gallup.com published in 2013

WASHINGTON, D.C. — Gallup published nearly 100 unique articles in 2013 about Americans\’ health and well-being. Through its daily surveys, conducted year-round, the Gallup-Healthways Well-Being Index uncovers new insights and provides the most up-to-date data available on Americans\’ mental state, exercise and eating habits, healthcare coverage, physical health, and financial well-being. The following list represents Gallup editors\’ picks for the top 10 most important findings from this year.

Lacking employment is most linked to having depression: For Americans, being unemployed, being out of the workforce, or working part time — but wanting full-time work — are the strongest predictors of having depression. Gallup found that these relationships hold true even after controlling for age, gender, income, education, race and ethnicity, marital status, having children, region, obesity, having health insurance, and being a caregiver. Bonus finding: Depression costs U.S. employers $23 billion in absenteeism each year.

Obesity is a growing problem for Americans: The adult obesity rate has been trending upward in 2013 will likely surpass rates since 2008, when Gallup and Healthways began tracking. The obesity rate has increased across almost all demographic groups.

Those who are actively disengaged at work are more likely to smoke: Eighteen percent of actively disengaged workers — those who are emotionally disconnected from their jobs — light up vs. 15% of other workers. Bonus finding: Workers who smoke cost the U.S. economy $278 billion annually.

Female veterans have a more optimistic life outlook: Female veterans of the U.S. military have a much more optimistic outlook on their lives than their male counterparts do. Female veterans\’ future life ratings are similar to those of women in the general U.S. population, but male veterans\’ ratings trail behind other men\’s ratings.

Heart attacks hit women harder, emotionally speaking: American women who say they have had a heart attack at some point in their lives have an average Emotional Health Index score that is eight points lower than the average score among women who have not had a heart attack. In comparison, the average Emotional Health Index score among men who have had a heart attack is four points lower than it is among men who have not.

Depression rate drops in areas hardest hit by Sandy: One year after Superstorm Sandy, reports of clinical depression among those living in the hardest hit areas have mostly recovered to levels seen before the storm. But reports of anger in the most affected areas have increased. Bonus finding: More residents smoke and fewer eat healthily than before the storm.

Income more to blame for obesity than food deserts: In a first-of-its-kind study exploring the relationship between adult obesity and food deserts, Gallup found that lack of access to grocery stores alone doesn\’t matter in terms of obesity; it only matters when Americans also have low incomes. But being low-income is associated with higher obesity rates, regardless of access to food.

Engaged employees have a healthier lifestyle: Employees who are engaged at work are more likely to report eating healthier, exercising more frequently, and consuming more fruits and vegetables than workers who are not engaged or who are actively disengaged.

Single-parent households struggle more to afford food: Thirty-one percent of single-parent households said there were times in the past 12 months when they struggled to afford food, compared with 19% two-parent households. Younger parents and parents with three or more children also had more trouble affording food at times.

Among U.S. workers, lack of exercise is linked more to obesity than eating habits: Exercising fewer than three days a week is more closely linked to U.S. workers being obese than any of 26 other behavioral factors, including healthy eating. This held true even while controlling for age, ethnicity, race, marital status, gender, income, education, region, and religiosity.

An aging America may not necessarily be a quiet and content America. People born in the post war boom, challenged religion, government and authority in all their forms. As an aging generation, they want the healthcare system to take care of them.

Baby boomers have grown up in what can be termed the age of technology and optimism, with mankind at the center of the universe and economic progress an ever churning engine. Much of the healthcare conversation in America is not about doctors and patients but about costs and insurance. Americans spend a great deal of money on healthcare. All the recent talk about healthcare seems to be impacting expectations on the role of doctors and healthcare outcomes. Americans expect doctors to save lives.

One of the challenges of healthcare in America is getting people to understand it, to connect their behavioral choices with healthcare outcomes and to value wellness over consumption. Feeling good does not always lead to feeling well. America can be an indulgent society and today’s youth want it all and they want it now. Americans do not value their healthcare until it is a problem they can feel or until they understand what is happening to them as something that can threaten their mortality. Americans want to live for ever and their attitudes regarding the role that a physician should play regarding preserving life is moving in that direction.

“At a time of national debate over health care costs and insurance, a Pew Research Center survey on end-of-life decisions finds most Americans say there are some circumstances in which doctors and nurses should allow a patient to die. At the same time, however, a growing minority says that medical professionals should do everything possible to save a patient’s …”

Pain is as old as complex cell organisms and greed is as old as the cave man.

What is relatively new is how scientists, corporations, (and even physicians trained to help people), engage the business of creating, distributing and profiting from medicines intended to help people but marketed to make money.

The company that reinvented and re-marketed the long used chemical compound called Oxycodone (Oxycodone is an analgesic medication synthesized from poppy-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, diacetylmorphine (heroin), and codeine.) as the new Oxycontin (a synthetic analgesic drug that is similar to morphine in its effects and subject to abuse and addiction.) has unleashed an epidemic that was inherent in a drug that needs much closer control and should be prescribed by properly trained physicians.

Are we our brother’s keeper? America seems to be increasingly divided in its opinions in what happens, and even in simply taking notice.

The verdict in Florida regarding the shooting of an unarmed teen should raise concern and key questions about guns, court systems, legal justice, race relations, and many other issues of import for the state of our Nation’s social fabric and for the future of an increasingly diverse if separate America. This separation seems to include what we notice and what we care about.

Be sure to visit the Policy ThinkShop for commentary on the importance of what happened in Florida for how after the legal system addressed the death of Trayvon Martin millions of people might now see America and how America sees millions of people through the eyes of our local police departments and justice systems.

The Pew Foundation has released a troubling survey about apathy and neglect for matters that should matter to all of us…

“The final days of the trial of George Zimmerman, which concluded July 13 with a verdict of not guilty, attracted relatively modest public interest overall. In a weekend survey, 26% say they were following news about the trial very closely.

This is lower than interest in the initial controversy over Trayvon Martin’s shooting when it erupted last year. In March 2012, 35% said they followed news about Martin’s shooting very closely.

However, the story has consistently attracted far more interest among blacks than whites – and that remained the case in the trial’s final days. Blacks are more than twice as likely as whites to say they tracked news about the Zimmerman trial very closely (56% vs. 20%).

Moreover, fully 67% of blacks say they watched at least some live coverage of the Zimmerman trial, compared with 38% of whites. About one-in-five blacks (21%) say they watched “almost all’’ of the trial coverage; just 5% of whites reported watching almost all of it.

The Pew Research Center survey was conducted July 11-14 among 1,002 adults. In 237 interviews conducted July 14, the day after the Zimmerman verdict, 29% say they were following news about the trial very closely.

The Zimmerman trial and Trayvon Martin shooting have drawn less interest than some other racially charged incidents in recent years, including the riots that followed the Rodney King verdict in 1992 (70% very closely) and O.J. Simpson’s arrest in 1994 (48%).”

We never think of ourselves as strangers, but others around us at one time or another surely will. For thousands of years groups of human beings have found ways to bond and build unity. Unfortunately, at the same time that we form the “we,” the “them” or the “other” is automatically formed. That is the fundamental basis of discrimination, judgement, bias and, yes, racism. It’s us against them. It’s “you and I are not the same and I don’t trust you.”

On that unfortunate night when George Zimmerman and Trayvon Martin met face to face, they both saw a stranger. George Zimmerman had already been armed and ready for “the stranger” and acted accordingly when he encountered a startled Trayvon Martin. Not much can really be said about that night because the only real witness was not a witness at all but a participant observer overwhelmed by his own fear, anger and pursuit of “the stranger in the night.”

Racism is but a word and concept that when put to the test of thought and reason falls short of describing the totality and complexity of many of the situations it, perhaps ironically, so often is a vital part of. Racism as an explanatory concept falls short because outside of “the human race” all the other constructs relating to race do not hold up to scientific scrutiny. There is only one kind of human being, though we are all quite different. Historically those differences have divided us and caused some of us to treat other people in inhumane ways. The construct of “White person” has been used historically to bring together a normally disparate collection of people. The early KKK included a diversity of people from different religions and ethnicities. This collection of disparate people were united in their apposition to the empowerment and liberation of antebellum South people–African Americans who had been enslaved because they were brought to America as muscle for work and were labeled, legally, as somewhere between animal and human. There is much psychosis and ill will in the history of the American Republic and as inheritors of that legacy, White people (however one defines the complex category) must live with that history. Black people must also live with that burden as victims and objects of hostility. As Americans, we all have a responsibility to address that past and to make sure that it does not dominate our present or future. There is no more important a challenge for the future of this Republic. America cannot go on closing its doors and incarcerating people who do not fit an antiquated norm.

America must work on reinventing itself and forging a culture that will better define what it expects from its citizens and one that is more attentive and inclusive of what it needs from the future than what it needs from its past. America must be more forward looking and embracing of people’s differences. That will not be easy… but it must happen. It cannot be done piecemeal through divisive movements and competition… Stakeholders in a future multicultural America must forge a value system that can be taught at home by parents, in school by teachers, at religious gatherings by spiritual leaders and in corporate America by managers. America increasingly looks different and we must figure out how to make the differences among us work if we are going to stay competitive in a competitive world.

Can America talk its way out of the race problem?

In important ways, racism speaks to the fears and phobias held deeply by people who fear black people, especially men America labels “black.” The reasons White people fear them may be debatable, but their discomfort with “the black stranger” cannot be explained away.

George Zimmerman was afraid and emotional enough that night, that he could not simply say: Good evening. What is your name? I am the neighborhood watch guy and I do not know you? Can we talk? Perhaps he could have said something like that and a simple conversation could have unraveled. Perhaps avoiding the confrontation that ensued.

When a person feels strong and negative feelings about another person, because they are strange and foreign to them, it is understandable. But when a person feels these feelings about a person who is black or African American, that person is acting on prior perceptions and images that are a part of American history and we, as a Nation, hardly know how to talk about that.

To be sure, the “we” here is those of us who frame these issues purely as racial, with little attention to the complexities that lead to intergroup mistrust and hostilities between so called “ethnic” or “racial” groups and the mainstream which is still presumed to be “White.”

But history is not simply Black and White. America is still not able to get over its “Black and White psychosis.” The mainstream American hegemonic culture has not processed differences and cultural conflicts between groups very well. That is the most deleterious outcome of its psychosis. Although White and Black hostilities are well documented and talked about, the lynching of Native Americans and Mexican Americans that went on in the mid and southwestern states is rarely mentioned. American consciousness and history is so twisted that today Hollywood portrays yesterday’s predominantly “brown” cowboys in the erroneous image of blond haired and blue eyed John Wayne. Intergroup competition, mistrust, hatred and violence are as old as the New England witch hunts, Southern White terror and abuse and exploitation of immigrants to America.

But intergroup competition and mistrust, intergroup hostilities in the face of reason and laws is not new. What is new is the proliferation of guns in our country–both urban and suburban, legal and illegal. Mistrust and divisions between groups that increasingly fuel and dominate our electoral politics and discourse do not bode well for an America that is already on guard about teenagers shooting up our schools and theaters, disgruntled and unstable young people blowing up Federal Buildings in Oklahoma, and homeland terrorism born of immigrants from anticommunism wars that armed and trained religious minorities throughout Europe, Asia and the Middle East. History is very much with us and we are doomed to repeat it. The violence that ensued between George Zimmerman and Trayvon Martin is very much embedded in racial history and mistrust. Mistakes happen, but guns have to be carrier by choice and how we define and treat one another in any situation has roots in how we were brought up and how “the other” looks and “feels” to us.

Hope lies in the hearts and minds of today’s young. But it will not survive for long if we allow police departments, States like Florida and the media establishment to make the mistakes and the politically motivated laws that promote vigilantism and hostility between neighbors. For example, the stand your ground law apparently does. What kind of society have we become that we allow excessive use of violence no matter what? In a diverse society where so many of us treat one another as “the other” or “the stranger” we cannot afford laws and court systems that allow anyone to define another person, and based on how they define that person, feel fear for their lives and kill them. That is insane and that is what is wrong with the Florida court system today.

Something is terribly wrong in American justice today. On the one hand, there is this slavery and civil rights history that is somewhat alien to most of today’s young people (today’s young people, of any race or ethnicity) and is somewhat stuck in the past for the rest of us. Civil rights is no longer about black and white. The country is much different today and in important ways the current generation that will matter, in terms of what happens in the next quarter century (young people between the ages of 15 to 35) is up at bat.

What are young people on all sides and from all communities going to do to make the future America kinder and gentler? What ever happened to community and neighborhood?

Greek myths, philosophy and architecture are often presented as the wellspring of Western civilization. However, science and reason are universal–so this time the wellspring is Yokohama City University in Japan.

The most hopeful use of stem cell research thus far and a breakthrough in growing cells in a way that now promises the increased possibility of full organ growth, brings us the amazing potential of curing much disease that currently cuts lives short.

“PROMETHEUS, a Titan bound to a rock by Zeus, endured the daily torture of an eagle feasting on his liver, only to have the organ regrow each night. Compared with this spectacle, a video on the website of Nature this week seems decidedly dull. It shows a collection of pink dots consolidating into a darker central glob.But something titanic is indeed happening. The pink dots are stem cells, and the video shows the development of a liver bud, something which can go on to look and act like a liver. Takanori Takebe and Hideki Taniguchi of Yokohama City University, in Japan, who made the video, have created working human-liver tissue.”

Individualism, the heroic individual, the leader, the father, the head of an organization and Norman Rockwell’s idilic physician all have one thing in common: the increasingly untenable belief that individualist leadership is the optimal form of guidance and decision making to meet our collective or individual needs.

Enter the case of the solo physician trying to navigate the increasingly complex internal and external realms of his/her medical practice.

The variables under consideration regarding an individual’s health status, those variables needed to understand the internal medical practice resources involved in assessing that status, those variables involved in the dynamics of the outside world of lifestyle and behavior causing or maintaining that status, and, perhaps more importantly, the complex healthcare system supporting the physician and the patient’s experience addressing the numerous communicative, behavioral and resource utilization issues involved in addressing that health status are as complex and exhausting as this very sentence.

Such is the healthcare system today. Hard to argue that we have not made progress from the days of low life expectancy, high child mortality and when, by today’s standards, low level infections caused serious health problems and even death.

The problem today seems much more complex and overwhelming as healthcare knowhow has become an information management problem. Computers and medical records do not seem to be helping much yet and the individualism involved in our national culture of choice and personal control seems to be militating against group progress.

The NYTs published a worthwhile article to get us thinking on this topic. The Policy ThinkShop recommends reading it and further discussion–discussion we can continue here at your Public Policy Blog …

“We physicians are susceptible to a kind of medical Stendhal syndrome as we confront the voluminous evidence about the clinical choices we face every day. It would take dozens of hours each week for a conscientious primary care doctor to read everything he or she needed in order to …”

Technology is changing war but legal concepts and international law are not as mutable. As governments and leaders enthusiastically move forward with technological efficacy, the legal morass and moral quandary caused by social, psychological and economic destruction promises to create new problems that may haunt us for generations. But technology moves fast, corporate America knows how to package and sell it, and the American public is the last to weigh in. Democracy is increasingly purchased in the ongoing divided American electorate and the internecine warfare election politics now represent. Like the proverbial Pyrrhic victory, we crush and pick off our enemies as the facts of our deeds slowly leek out and we potentially stand in ubiquitous and unforgiving popular judgement at home and abroad.

We seem to be getting farther and farther away from “though shall not kill” and “violence begets violence”

At last we have a technological equivalent to hackers threatening social and economic information exchange where the government is “anonymous” and civilization itself is the victim. It is legion, expect it…

“WHEN it comes to lethal drone strikes against foreign targets, America’s government and Congress should be aware that “what is sauce for the goose is sauce for the gander”, says …”

What’s the best way to “fix” a narrowed coronary artery? That question was the crux of a multimillion-dollar trial dubbed COURAGE, short for Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation. Its results, presented in the spring of 2007, stunned some doctors and seemed to shock the media, but we hope they won’t come as a surprise to readers: For people with stable coronary artery disease (clogged arteries nourishing the heart), artery-opening angioplasty was no better than medications and lifestyle changes at preventing future heart attacks or strokes, nor did it extend life.

It is dumbfounding! It paralyzes the brain, the heart and almost all hope–without need for audacity.

Ph.D.s, advocates, health professionals, and good old moms and dads come to the agreement that healthcare needs changing and that sick people should get help–especially those who have difficulty getting it. Presumably, it is logical and reasonable to think that many of these people are what we, all of us for hundreds of years, have called “the poor.”

Yet for as long as there have been those with and those without, those with often have the efficacy to get more and those without, perhaps by definition, get even less–always…

So here we are well into healthcare reform and the NYT is sounding the whistle on the haves once again–millions have been spent and the poor are somehow invisible once again when it comes to targeting the needs of those who are hurting and are having a difficult time getting good, reliable, continuos, patient centered, medical home care! Go figure… or better yet, go read the New York times…

“The refusal by about half the states to expand Medicaid will leave millions of poor people ineligible for government-subsidized health insurance under President Obama’s health care law even as many others with higher incomes receive federal subsidies to …”

Drugs have serious, and sometimes fatal, side effects and too often unintended consequences. But we are sick, and health professionals somehow perform a cost benefit analysis and risk assessment and recommend that we take this drug or that to help us deal with our health condition or else.

Medicine is evolving, medicines are just one variable in a complex medical intervention process and people simply do not behave well or as needed very often.

Like variables that are introduced to repair a broken swiss watch, drugs enter our body system and fix some things yet disturb others.

Medical interventions, as drug therapies, change our blood chemistry and many of the vital functions of our major organs and personal health processes in some way…

As our body systems and organs fail under the weight of heredity, diet, behavior, etc., scientists perform research and through trial and error attempt to produce substances that can be introduced into our sick body systems to address a needed substance or desired cause and effect to make us better.

Our lives and bodies are similar, so research has some success, in a controlled experiment, showing that symptoms can be changed or controlled. However, implementing these medical solutions in the daily routine of our unique yet complex lives is another story.

Diet, exercise and behavior in general are also modified when we become sick and our body changes due to powerful drugs we are advised to take.

As each of us goes through life experiencing disease, we benefit from therapies, if we are “lucky” enough to have access to them, in varying ways.

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